I do believe Jahi's body is capable of movement, and likely is moving, but just not in the manner that Omari Sealey and Nailah Winkfield have interpreted.
I have written a longish article for another site reviewing Dr. Alan Shewmon's work, but am not able to publish it at the moment. It's kind of too long for a post here, but I'll hit some of the highlights for those interested.
Dr. D. Alan Shewmon is a prominent Professor of Pediatric Neurology at UCLA Medical School. While some of his ideas about somatic integration are controversial among his Neurology peers, I think many would also agree that Dr. Shewmons academic curiosity about the continued function of the body organ systems in somatic-supported brain dead individuals has contributed greatly to the very scarce fund of clinical research on the brain dead. HIs 1998 published meta analysis of all available brain dead patients who had received somatic support is of particular significance, IMO, as it outlines the same pattern of events in all cases reviewed that we have seen in the past 6 months with Jahi McMath's extended somatic support.
This is what he described about the boy, "TK", who had brain death at age 4 from meningitis, and received somatic support (ventilator care, tube feedings, and periodic antibiotics and IV support during hospitalizations). He observed spinal mediated movements as such in approximately 1998, when TK was 18 years old:
So he and all the other patients were very unstable in the beginning. They required pressor medications. But they were able to wean off the pressor medications, and he remained stable in terms of self-sustained blood pressure on his own. He could tolerate a sitting position, which indicates some degree of autonomic control of the blood pressure. So his blood pressure didn't plummet from blood pooling into the legs upon sitting.
So the organism reacts to these environmental stressors in a coordinated manner. Let me now show you his video. He has hyperactive reflexes. He has what we call a triple flexion response where you elicit this Babinski reflex, and the entire legs at hip, knee, and ankle will withdraw.
And what I think is quite interesting in a few other segments that will briefly come is when I pinch his shoulder the leg will move. So there's integration within the spinal cord across levels of spinal cord. I don't think such movements have any survival value, but it's a sign that the spinal cord is doing a lot of integration there, including autonomic integration, and that's what's important in the somatic organism. So when he's uncovered he did get goose bumps, and he had mottling of the skin.
https://bioethicsarchive.georgetown.edu/pcbe/transcripts/nov07/session5.html
The important, take home message, is that for all of the cases he has reviewed of prolonged somatic support in a brain death situation (not comatose, or PVS-- clearly brain dead), there is a period of spinal shock, exactly similar to what is seen clinically in very high spinal cord injuries. Then a period of autonomic and spinal cord stabilization. I think that is likely what is being seen in Jahi's situation, and what is described by the family-- that she maintains her temperature with blankets, has weaned to room air concentrations of oxygen, and exhibits movement that is consistent with spinal cord reflexive activity. Their "interpretation" that she moves in response to voice commands is of high suspicion, and would have to be validated by specialists for me to give any credit to that as truthful.
The other take away message is that for the patients Dr. Shewmon has studied in his meta-analysis, there are about 2 important milestones in the time period of somatic support where cardiac activity stops. One point is around 2-3 months, the other is at 6 months to one year. (See the scatter plots within the article.)
Here is the abstract:
Article abstract-Objective: One rationale for equating brain death (BD) with death is that it reduces the body to a mere collection of organs, as evidenced by purported imminence of asystole despite maximal therapy. To test this hypothesis, cases of prolonged survival were collected and examined for factors influencing survival capacity. Methods: Formal diagnosis of BD with survival of 1 week or longer. More than 12,200 sources yielded approximately 175 cases meeting selection criteria; 56 had sufficient information for meta-analysis. Diagnosis was judged reliable if standard criteria were described or physicians made formal declarations. Data were analyzed by means of Kaplan-Meier curves, with treatment withdrawals as censored data, compared by log-rank test. Results: Survival probability over time decreased exponentially in two phases, with initial half-life of 2 to 3 months, followed at 1 year by slow decline to more than 14 years. Survival capacity correlated inversely with age. Independently, primary brain pathology was associated with longer survival than were multisystem etiologies. Initial hemodynamic instability tended to resolve gradually; some patients were successfully discharged on ventilators to nursing facilities or even to their homes. Conclusions: The tendency to asystole in BD can be transient and is attributable more to systemic factors than to absence of brain function per se. If BD is to be equated with death, it must be on some basis more plausible than loss of somatic integrative unity. NEUROLOGY 1998;51:1538-1545
http://www.uned-illesbalears.net/Tablas/vida5.pdf
Of course, none of us know how long Jahi's heart can continue, but given the results of the meta-analysis, and the circumstances of her brain death (presumably anoxia secondary to either airway obstruction, or cardiac arrest, or both, but not multi system trauma or disease), and her relatively youthful age at brain death, it seems likely we could predict her heart to continue up to a year, "or so", since her body has maintained cardiac function beyond the first 2-3 month period.
Oh-- thought I'd add this, because interpreting scientific literature can be challenging.
"What is a meta analysis?"
In statistics a meta-analysis refers to methods that focus on contrasting and combining results from different studies, in the hope of identifying patterns among study results, sources of disagreement among those results, or other interesting relationships that may come to light in the context of multiple studies.
More generally there are other differences between the studies that need to be allowed for, but the general aim of a meta-analysis is to more powerfully estimate the true effect size as opposed to a less precise effect size derived in a single study under a given single set of assumptions and conditions. A meta-analysis therefore gives a thorough summary of several studies that have been done on the same topic, and provides the reader with extensive information on whether an effect exists and what size that effect has.
Meta analysis can be thought of as "conducting research about research."
http://en.wikipedia.org/wiki/Meta-analysis
